I keep hearing the same phrases in conversations with parents and other professionals: “He’s stuck in dorsal.” “We need to get her back into ventral.” Sometimes someone asks me whether a particular program will help “tone the vagus nerve.”
I understand the appeal. When you’re watching a child shut down over homework, or an adult freeze in front of a task they know how to do, you want an explanation that makes sense of what you’re seeing. Polyvagal theory offers one. It also offers language that feels kinder than “lazy,” “oppositional,” or “not trying.” That shift matters.
But I’ve become increasingly uncomfortable with how often the language is presented as established physiology. I’m a developmental researcher and an executive function specialist. In my work, I see what stress can do to planning, initiation, working memory, and flexibility. I don’t need convincing that a person’s state affects what they can do. What I do need is a good reason to accept a particular account of why that happens.
The part I can’t get past
Polyvagal theory is often taught as though the nervous system moves among distinct “ventral vagal,” sympathetic, and “dorsal vagal” states, each with its own behavioral meaning. It’s a compelling story. The problem is that important parts of that story are disputed by researchers who study the relevant anatomy and physiology.
This isn’t a new disagreement. Grossman and Taylor (2007) questioned key claims about respiratory sinus arrhythmia and vagal tone years ago. More recently, a group of 39 researchers published an extensive critique arguing that the theory’s central physiological claims are not supported (Grossman et al., 2026). Porges (2026) has responded that critics have mischaracterized his theory. Readers should know that response exists.
Three issues stand out to me. First, respiratory sinus arrhythmia—the way heart rate changes with breathing—is not a straightforward gauge of “vagal tone” in the way it is sometimes described. A 2025 expert recommendation even proposed clearer terminology to avoid that inference (Menuet et al., 2025). Second, the evolutionary narrative is difficult to square with comparative evidence of similar cardiorespiratory patterns in other vertebrates (Taylor et al., 2022). Third, the vagal anatomy doesn’t neatly divide into the two behavioral systems often shown in diagrams (Neuhuber & Berthoud, 2022).
None of this means that people aren’t experiencing real changes in arousal, attention, or behavior. It means the tidy map may not be an accurate map of the underlying biology. And that distinction matters when we explain an intervention to a family.
Why the ideas still resonate
One thing polyvagal language has done well is give people a way to look at difficult behavior without immediately assigning blame. A child who melts down during a transition may be overwhelmed, not deliberately difficult. Someone who can’t start a task may need support, not another lecture about motivation.
I want to keep that shift. I just don’t think it belongs exclusively to polyvagal theory. Developmental science has long emphasized responsive caregiving, co-regulation, stress, and the importance of context. Those ideas stand on their own; they don’t become more credible because we attach a specific vagal explanation to them (Grossman et al., 2026).
What this looks like in executive function coaching
A familiar situation in my work: someone talks through a plan with me and understands it completely. They know what the assignment requires. They can name the first three steps. Then the deadline gets close, anxiety rises, and they can’t begin.
I don’t find it helpful to tell that person their nervous system has entered a particular vagal state. I’m more interested in what has changed about the demands on their attention and working memory. We have substantial evidence that acute stress can disrupt prefrontal functions involved in planning, working memory, and flexible thinking (Arnsten, 2009). That explanation gives me something concrete to work with.
Maybe we open the document together and write one imperfect sentence. Maybe I take the sequence of steps out of their head and put it on paper. Maybe we remove decisions, build a predictable routine, take a short movement break, or sit alongside them while they get started. I’m not claiming every strategy works for everyone. I want to see whether it actually helps this person do the thing they’re trying to do.
That’s one reason I’m cautious about explanations that sound complete before we’ve even observed what works. The language can make us feel like we understand a problem when we’ve only renamed it.
What I ask about programs built around the theory
Families sometimes ask me about interventions marketed using polyvagal concepts, including the Safe and Sound Protocol. I don’t dismiss a family’s report that something helped. If a child is less distressed by sound or finds an experience calming, that’s worth taking seriously.
At the same time, a positive experience is not the same as strong evidence for the intervention—or for the theory used to market it. A controlled study of an earlier listening protocol reported preliminary improvements in auditory sensitivity among autistic children (Porges et al., 2014). A later review discussed promising applications but also called for larger controlled trials (Gitler et al., 2025). That’s a reason for measured curiosity, not certainty.
Clinical treatment decisions belong with the family’s qualified providers. My role is to help families think clearly about the claims they’re hearing. I usually want to know: What evidence is there for this particular intervention? What specific change are we hoping to see, and over what period? How will we know if it’s helping? And what are the costs—not only financial, but in time and energy that could go toward something else?
Those questions aren’t hostile. They’re the same questions I’d ask about any intervention, whether or not I liked the theory behind it.
Where I’ve landed
I don’t think we need to throw away every useful practice that has been associated with polyvagal theory. I also don’t think we should keep repeating a physiological explanation simply because it gives people a reassuring story.
For me, the standard is straightforward: be compassionate about what people experience, careful about what the science actually establishes, and willing to change course when the evidence changes. If connection, predictability, reduced demands, or practical scaffolding help someone function better, that’s worth knowing. We can keep what works without pretending we know more about the vagus nerve than we do.
References
Arnsten, A. F. T. (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410–422. https://doi.org/10.1038/nrn2648
Gitler, A., Bar Yosef, Y., Kotzer, U., & Levine, A. D. (2025). Harnessing non-invasive vagal neuromodulation: HRV biofeedback and SSP for cardiovascular and autonomic regulation (Review). Medicine International, 5(4), 37. https://doi.org/10.3892/mi.2025.236
Grossman, P., Ackland, G. L., Allen, A. M., Berntson, G. G., Booth, L. C., Burghardt, G. M., Buron, J., Dinets, V., Doody, J. S., Dutschmann, M., Farmer, D. G. S., Fisher, J. P., Gourine, A. V., Joyner, M. J., Karemaker, J. M., Khalsa, S. S., Lakatta, E. G., Leite, C. A. C., Macefield, V. G., ... Zucker, I. H. (2026). Why the polyvagal theory is untenable: An international expert evaluation of the polyvagal theory and commentary upon Porges, S. W. (2025). Polyvagal theory: Current status, clinical applications, and future directions. Clinical Neuropsychiatry, 23(1), 100–112. https://doi.org/10.36131/cnfioritieditore20260110
Grossman, P., & Taylor, E. W. (2007). Toward understanding respiratory sinus arrhythmia: Relations to cardiac vagal tone, evolution and biobehavioral functions. Biological Psychology, 74(2), 263–285. https://doi.org/10.1016/j.biopsycho.2005.11.014
Menuet, C., Ben-Tal, A., Linossier, A., Allen, A. M., Machado, B. H., Moraes, D. J. A., Farmer, D. G. S., Paterson, D. J., Mendelowitz, D., Lakatta, E. G., Taylor, E. W., Ackland, G. L., Zucker, I. H., Fisher, J. P., Schwaber, J. S., Shanks, J., Paton, J. F. R., Buron, J., Spyer, K. M., ... Gourine, A. V. (2025). Redefining respiratory sinus arrhythmia as respiratory heart rate variability: An international Expert Recommendation for terminological clarity. Nature Reviews Cardiology, 22(12), 978–984. https://doi.org/10.1038/s41569-025-01160-z
Neuhuber, W. L., & Berthoud, H.-R. (2022). Functional anatomy of the vagus system: How does the polyvagal theory comply? Biological Psychology, 174, 108425. https://doi.org/10.1016/j.biopsycho.2022.108425
Porges, S. W. (2026). When a critique becomes untenable: A scholarly response to Grossman et al.’s evaluation of polyvagal theory. Clinical Neuropsychiatry, 23(1). https://doi.org/10.36131/cnfioritieditore20260111
Porges, S. W., Bazhenova, O. V., Bal, E., Carlson, N., Sorokin, Y., Heilman, K. J., Cook, E. H., & Lewis, G. F. (2014). Reducing auditory hypersensitivities in autistic spectrum disorder: Preliminary findings evaluating the listening project protocol. Frontiers in Pediatrics, 2, 80. https://doi.org/10.3389/fped.2014.00080
Taylor, E. W., Wang, T., & Leite, C. A. C. (2022). An overview of the phylogeny of cardiorespiratory control in vertebrates with some reflections on the “Polyvagal Theory.” Biological Psychology, 172, 108382. https://doi.org/10.1016/j.biopsycho.2022.108382